Poster 35: Bilateral spontaneous iliacus hematomas presenting as incomplete paraplegia: a case report

Abstract

Setting: A Midwest acute care and subsequent inpatient rehabilitation hospital. Patient: A 54-year-old obese white woman with diabetes mellitus type 2 requiring insulin. Case Description: The patient underwent a Rou-en-Y gastric bypass and had an uncomplicated immediate postoperative course. She was discharged home on postoperative day 4. On postoperative day 8, she was readmitted to the hospital with diabetic ketoacidosis requiring intubation and aggressive supportive care. She was successfully extubated 10 days later, and recalled standing at the bedside with her physical therapists. 2 days after extubation, she had respiratory distress requiring reintubation and the diagnosis of pulmonary emboli (PE) was entertained. The patient was put on anticoagulants for 2 days while the work-up for PE was completed; the work-up was negative for embolic phenomenon. After successful extubation, she reported severe bilateral lower-limb weakness, pain, inability to void, and diarrhea with incontinence. A diagnosis of steroid myopathy was presumed by the primary team and the patient was transferred on postoperative day 40 to acute rehabilitation. On admission to rehabilitation, her examination revealed bilateral proximal greater than distal weakness with primarily femoral nerve involvement. Electrodiagnostic studies revealed diffuse membrane instability in all lower-limb myotomal distributions, including paraspinals. Magnetic resonance imaging of the lumbar spine was unremarkable and computed tomography of the pelvis revealed chronic bilateral iliacus muscle hematomas with compression of the femoral nerves. The patient was not thought to be a surgical candidate and so was managed conservatively. Assessment/Results: Bilateral iliacus hematomas with femoral nerve and lumbar plexus compression. Discussion: Bilateral spontaneous iliacus hematomas are an extremely rare complication. Conclusion: Early surgical intervention may significantly limit morbidity, and therefore, this diagnosis should be considered in all patients with lower-limb weakness presenting after anticoagulation.